Ziprasidone

Introduction

Written by Kirstyn Hill, PharmD, MPH
Medically reviewed by Melissa Badowski, PharmD, MPH, FCCP
Updated on August 25, 2023

Ziprasidone (zi PRAS i done) is a generic medication prescribed for certain mental health conditions in adults. Ziprasidone belongs to a group of drugs called atypical antipsychotics.

The Food and Drug Administration (FDA) has approved ziprasidone to treat the following in adults:

• schizophrenia
• acute (sudden) manic or mixed episodes due to bipolar I disorder
• maintenance (ongoing) treatment of bipolar I disorder, when taken with the antipsychotic medications lithium (Lithobid) or valproate
• agitation due to schizophrenia

These approved uses differ based on the form of ziprasidone your doctor prescribes.

This article doesn’t provide coupons for all forms of ziprasidone. To find coupons for ziprasidone oral capsule, see this article.

Boxed warning: Increased risk of death in older adults with dementia-related psychosis

Ziprasidone has a boxed warning about the increased risk of death in older adults with dementia-related psychosis. Boxed warnings are the most serious warnings from the FDA.

For details, see the “Interactions and warnings for ziprasidone” section.

Side effects of ziprasidone

Ziprasidone may cause mild or serious side effects. More common mild side effects of ziprasidone and its serious side effects are listed below. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.

To learn more about ziprasidone’s side effects, ask your doctor or pharmacist. You can also refer to the prescribing information for ziprasidone listed in the “Resources” section.

Mild side effects

More common mild side effects reported with ziprasidone injection and oral capsule are listed below. These side effects may differ based on the form of ziprasidone you use.

This article doesn’t include all possible mild side effects of the drug. To learn more about ziprasidone’s side effects based on the form, refer to the prescribing information for ziprasidone listed in the “Resources” section.

With many drugs, mild side effects may go away within a few days or a couple of weeks. If the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.

Ziprasidone injection’s* mild side effects include:

• headache
• injection site pain
• nausea
• drowsiness
• mild allergic reaction†

Ziprasidone oral capsule’s mild side effects include:

• weight gain
• weakness
• respiratory tract infection
• drowsiness or somnolence
• mild allergic reaction†

* A healthcare professional will give this form as an injection into a muscle.
† For details about this side effect, see the “Interactions and warnings for ziprasidone” section.

Serious side effects

Serious side effects of ziprasidone are listed below.

This article doesn’t include all possible serious side effects of the drug. To learn more about ziprasidone’s side effects based on the form, refer to the prescribing information for ziprasidone listed in the “Resources” section.

With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number.

In general, ziprasidone’s serious side effects include:

• orthostatic hypotension (fainting when standing due to low blood pressure)
• events involving blood vessels in the brain, such as stroke
• atypical heart rhythms, including long QT syndrome
• neuroleptic malignant syndrome, a rare but serious reaction to using certain drugs such as ziprasidone
• drug reaction with eosinophilia and systemic symptoms (DRESS), which can be life threatening
• high blood sugar level
• high cholesterol level
• low white blood cell count
• seizure
• difficulty swallowing
• high level of the hormone prolactin
• suicidal thoughts or behaviors
• problems regulating body temperature
• extrapyramidal symptoms (movement disorders), such as muscle contractions and tremors
• tardive dyskinesia (uncontrolled movements of the face and sometimes the body)
• boxed warning: risk of death in older adults with dementia-related psychosis*
• severe allergic reaction*

* For details about this side effect, see the “Interactions and warnings for ziprasidone” section.

Suicide prevention

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

• Call the 988 Suicide and Crisis Lifeline at 988.
• Text HOME to the Crisis Textline at 741741.
• Not in the United States? Find a helpline in your country with Befrienders Worldwide.
• Call 911 or your local emergency services number if you feel safe to do so.

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you are not in the same household, stay on the phone with them until help arrives.

Common questions about ziprasidone

Below you’ll find answers to a few commonly asked questions about ziprasidone.

What brand names are available for ziprasidone?

The brand-name version of ziprasidone is called Geodon. Like generic ziprasidone, Geodon comes in the form of an oral capsule and an injection given into a muscle.

A generic medication is an identical copy of the active drug in a brand-name medication. (An active drug is the ingredient that makes a medication work.) Generic drugs are believed to be as effective and safe as brand-name drugs. And generic drugs typically cost less compared with brand-name drugs. For more information on brand versus generic drugs, see this article.

Does ziprasidone cause long-term side effects?

Yes, in some cases, ziprasidone may cause long-term side effects. This term refers to side effects that may occur if you take the drug for a long time. It also means side effects that last for a while after you’ve stopped taking the drug. Long-term side effects may differ based on the form of ziprasidone you take.

Examples of long-term side effects include:

• weight gain
• tardive dyskinesia (uncontrolled movements of the face and sometimes the body)
• high blood sugar levels

Talk with your doctor to learn more about these side effects and how to best manage them. Ask your doctor for more information about how long these side effects of ziprasidone may last.

Is ziprasidone similar to risperidone or Abilify?

Ziprasidone (Geodon), risperidone (Risperdal, Perseris, Uzedy), and aripiprazole (Abilify) are all atypical antipsychotics that are used to treat certain mental health conditions. All of these medications are prescribed to treat schizophrenia in adults. Some may be prescribed to certain children for this purpose, and some have uses that differ.

Ziprasidone is available as an injection given into muscle and an oral capsule. Abilify is available only as an oral tablet. But its generic, aripiprazole, is available as an oral tablet, oral solution, and orally disintegrating tablet (ODT). Risperidone is also available as an oral tablet, oral solution, and ODT. Some of risperidone’s brand-name versions are available in other forms.

If you’d like to know more about how ziprasidone, risperidone, and Abilify compare, talk with your doctor or pharmacist.

How does ziprasidone work? And how long does it take to start working?

How ziprasidone works isn’t fully known. Studies have shown that the drug affects the level of dopamine and serotonin in your brain. Changing the levels of these chemicals in your brain helps to improve mood.

The ziprasidone injection works in your body right away, while the oral tablet usually takes about 3 days. It may take several weeks to notice a difference in your symptoms.

If you’d like to know more about how ziprasidone works, talk with your doctor or pharmacist.

Interactions and warnings for ziprasidone

Below, you’ll find information about ziprasidone’s possible interactions and warnings.

Interactions of ziprasidone

Certain things may affect how a drug works. These include getting vaccines, consuming alcohol or certain foods, or taking the drug with other medications. This effect is called a drug interaction.

Before you use ziprasidone, ask your doctor to check for possible interactions. Be sure to tell them about any of the following you take or use:

• prescription or over-the-counter drugs
• vitamins, herbs, or supplements

To learn about drug-condition interactions, see the “Warnings for ziprasidone” section below.

Warnings for ziprasidone

Some people should not use ziprasidone, and others should use it cautiously.

Boxed warning: Increased risk of death in older adults with dementia-related psychosis

Ziprasidone has a boxed warning about the increased risk of death in older adults with dementia-related psychosis. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA).

With dementia, you have problems with communication, thinking, and memory. With psychosis, you lose touch with reality.

Adults ages 65 years and older with dementia-related psychosis have an increased risk of death while taking ziprasidone. The most commonly reported causes of death in older people with this condition who took ziprasidone were:

• cardiovascular (heart and blood vessel) problems, such as heart failure and stroke
• infections, such as pneumonia

If you have concerns about this boxed warning, talk with your doctor or pharmacist.

Other warnings

Ziprasidone could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether ziprasidone is a safe option for you. These warnings may differ based on the form of ziprasidone you use.

Ask your doctor about specific warnings for ziprasidone, and be sure to tell your doctor about your:

• current health, including any allergies to medications
• past health conditions or surgeries

Allergic reaction

Ziprasidone can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.

If you’ve had an allergic reaction to ziprasidone or any of its ingredients, your doctor will likely not prescribe ziprasidone. They can tell you about medications that are safer options for you.

A mild allergic reaction may cause the following symptoms:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A severe allergic reaction may cause the following symptoms:

• swelling under your skin, usually in your hands, feet, eyelids, or lips
• swelling of your mouth, throat, or tongue, which can cause breathing problems

If you have an allergic reaction to ziprasidone, call your doctor right away. If you have severe symptoms, call 911 or a local emergency number.

Overdose of ziprasidone

If you take ziprasidone by mouth, you should not take more ziprasidone than your doctor prescribes. For some drugs, doing so may lead to harmful effects or overdose.

If you think you’ve taken too much ziprasidone, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

Pregnancy or breastfeeding and ziprasidone

Information about ziprasidone and pregnancy and breastfeeding is described below.

Ziprasidone and pregnancy

There are risks to using ziprasidone during pregnancy. But there are also risks with having unmanaged mental health conditions while pregnant. (Keep in mind that ziprasidone is used for the management of mental health conditions such as schizophrenia and bipolar I disorder.)

If you’re planning a pregnancy or can become pregnant, talk with your doctor about mental health treatment options during pregnancy. Together, you can discuss the risks and benefits of your treatment options and decide whether or not you should take ziprasidone during pregnancy.

If you take ziprasidone during pregnancy, your doctor may suggest enrolling in the National Pregnancy Registry for Atypical Antipsychotics. This registry monitors outcomes of taking atypical antipsychotics, such as ziprasidone, during pregnancy. To learn more, call 866-961-2388 or visit the registry website.

Ziprasidone and breastfeeding

There are risks to using ziprasidone while breastfeeding. For instance, ziprasidone may cause sleepiness, irritability, and difficulty feeding in a child who’s breastfed.

But there are also risks with having unmanaged mental health conditions during this time. (Keep in mind that ziprasidone is used for the management of mental health conditions such as schizophrenia and bipolar I disorder.)

If you’re planning to breastfeed, talk with your doctor about mental health treatment options. Together, you can discuss the risks and benefits of your treatment options and decide whether you should take ziprasidone during this time. Your doctor may recommend other healthy ways to feed your child.

Uses of ziprasidone

The Food and Drug Administration (FDA) approves prescription drugs such as ziprasidone for certain conditions. Approved uses for ziprasidone are described below. These uses differ based on the form of ziprasidone prescribed.

Use for certain mental health conditions

Doctors may prescribe ziprasidone oral capsule or injection given into a muscle for treating certain mental health conditions in adults.

For the conditions listed below, Ziprasidone oral capsule is usually prescribed as a long-term treatment:

• schizophrenia
• maintenance (ongoing) treatment of bipolar I disorder when taken with the antipsychotic medications lithium (Lithobid) or valproate

Ziprasidone oral capsule can also be used short term for treatment of acute (sudden) manic or mixed episodes associated with bipolar I disorder.

Schizophrenia and bipolar I disorder may affect your feelings, behavior, and thoughts. Depending on which condition you have, symptoms can vary but may involve sudden changes in mood or behavior.

With manic episodes of bipolar I disorder, you feel extremely energetic or “up,” with episodes lasting at least 1 week. With mixed episodes of this condition, you have depressive (low mood) and manic (high mood) symptoms at the same time.

Ziprasidone injection is prescribed to treat agitation in adults with schizophrenia. It’s usually prescribed as a short-term treatment.

Agitation is a symptom of schizophrenia that can come on suddenly. It can result in intense anxiety, aggression, or restlessness.

What to ask your doctor

Let your doctor know if you have questions about ziprasidone or would like more details about it.

Here’s a list of some possible questions you may want to ask your doctor:

• Are there any alternative medications I can take for my condition?
• What happens if I miss a dose of ziprasidone?
• What drugs should I avoid while taking ziprasidone?

Resources

• Food and Drug Administration. (2023). Orange Book: Approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm
• Ziprasidone capsules, for oral use. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/61e3fa7b-61c2-4d5d-a6b3-2618c15a6bd9/spl-doc
• Ziprasidone mesylate for injection, for intramuscular use. (2022). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/90b35a26-ab65-4c39-b97f-55c8c0e34b0b/spl-doc

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.